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Membership Form
Please fill out form
completely. Make check payable to Tri Gulfcoast and mail to:
TRI Gulfcoast
PO Box 544
Gulf Breeze, FL 32562-0544
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First Name:
Last Name:
Age:________
Birthdate:____/____/____
Address:
City, State, Zip:
Phone numbers: Home:
(____)____-______ Business: (____)____-______
USAT Member#:
________________ Fax#: (____)____-______
Email
address:_______________________________________________
| Check One: |
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New Member |
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Renewal |
| Check One: |
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Annual Individual $15.00 |
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Annual Family $20.00 |
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family Membership, list additional family members and birth dates: |
Name |
Birth Date |
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I agree to abide by
all
decisions made by the club and its board. I understand and assume all
risks
associated while participating in all club sponsored events. I will not
participate unless I am medically fit and properly trained. having read
this waiver and knowing these facts and in consideration of the
acceptance
of my application for membership, I, for myself and anyone entitled to
act
on my behalf, waive and release TRI Gulf Coast and all sponsors, their
representatives
and successors from all claims or liabilities of any kind arising out
of
my participation in these club activities even though that liability
may
arise out of negligence or carelessness on the part of persons named in
this waiver.
Signature:___________________________
Date:__________
Parent/Guardian if under
18:__________________________ Date:__________
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